Provider Demographics
NPI:1417092594
Name:ST. RAYMOND, MICHELLE ALYS (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALYS
Last Name:ST. RAYMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:STREIFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1934 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5841
Mailing Address - Country:US
Mailing Address - Phone:985-674-4113
Mailing Address - Fax:985-674-4113
Practice Address - Street 1:1934 MADISON ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5841
Practice Address - Country:US
Practice Address - Phone:985-674-4113
Practice Address - Fax:985-674-4113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA586309OtherVALUE OPTIONS PROVIDER